child psychiatry: key concepts and clinical insights · 1. what does a child psychiatry diagnosis...
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Child psychiatry: Key concepts and clinical insights
Professor Vance
Outline of Presentation:
1. What does a child psychiatry diagnosis mean?2. Why clinical interview and questionnaires are helpful3. Key comorbid conditions within a developmental context4. Nature versus nurture – some comments5. Key biological factors6. Key psychosocial factors7. Key principles of treatment
Professor Vance
1. What does a child psychiatry diagnosis mean?
a behavioural or psychological pattern of symptoms
associated with
impairment in family, social and/or academic domains
Professor Vance
1. What does a child psychiatry diagnosis mean?
in children and adolescents-
developmentally inappropriate impairment has to be judged relative to children of the same age, gender and IQ
this requires longitudinal assessment within and acrossdevelopmental stages
Professor Vance
1. What does a child psychiatry diagnosis mean?
multi-informant report - parent, teacher, child
low concordance repeatedly shown
externalizing: parent-teacher: increased agreementinternalizing: child-teacher: increased agreement
Professor Vance
-high prevalence psychiatric disorders-
‘externalizing’ oppositional defiant disorderconduct disorder
attention deficit hyperactivity disorder
‘internalizing’ anxiety disorders
depressive disorder
Professor Vance
2. Why clinical interview and questionnaires are helpful
Professor Vance
2. Why clinical interview and questionnaires are helpful
greater than 1.5 standard deviations from the meanbrain and environment behave differently
as if a clinical ‘threshold’ has been crossed
Professor Vance
3. Key comorbid conditions within a developmental context
oppositional defiant/conduct disordersanxiety disordersdepressive disorderslearning disorders (language-based/visuo-spatial)developmental coordination disorder
Professor Vance
Professor Vance
4. Nature versus nurture – some comments
nature primary driver
primary driver nurture
nature nurture
common antecedent
Professor Vance
Professor Vance
Professor Vance
5. Key biological factors
Executive functioning
Response inhibition: motor and cognitionoptimise response speed and accuracy
Working memory: verbal and visuospatialoptimise span and strategy
5. Key biological factors
Mood dysregulation: decrease irritabilityincrease emotional salience
Arousal dysregulation: optimise physiological arousaloptimise habituation
Professor Vance
6. Key psychosocial factors
[A]parental psychopathology: alcohol/depressive/anxiety ds
[B] marital functioning:
family functioning:
peer group functioning:
“flexibility/adaptiveness/regulation of affect/problem solving”
sociocultural context affects the character of these aspectsand their detection
Professor Vance
Professor Vance
7. Key principles of treatment
1. maximize the psychological and social context in which the child is immersed to maximize the child’s learning environment
“consistent, attuned, sensitive and responsive…”
2. medications can be helpful to facilitate the child’s ability tolearn in home and school environments
3. each child needs complete re-review every six months
Professor Vance
Professor Vance